Provider Demographics
NPI:1093862377
Name:HERIVEAUX, DOMINIQUE JULIE (RN)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:JULIE
Last Name:HERIVEAUX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 HAMMOCKS BLVD # 470
Mailing Address - Street 2:SUITE 153
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4712
Mailing Address - Country:US
Mailing Address - Phone:786-488-5955
Mailing Address - Fax:305-380-0756
Practice Address - Street 1:10201 HAMMOCKS BLVD # 470
Practice Address - Street 2:SUITE 153
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4712
Practice Address - Country:US
Practice Address - Phone:786-488-5955
Practice Address - Fax:305-380-0756
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45010171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator